Ovarian Cancer: The Gynecologic Cancer with Hidden Symptoms — CA125, Diagnosis, and Treatment Explained

Ovarian cancer is a malignant tumor that starts in the ovaries, with epithelial ovarian cancer being the most common type. The ovaries are located deep in the pelvis, giving tumors ample space to grow quietly, so there are almost no symptoms in the early stages. In addition, symptoms like bloating and abdominal pain are easily confused with digestive issues, and many patients are already at an advanced stage when diagnosed.

Although ovarian cancer is called a 'silent killer,' treatment is not without hope: the combination of surgery and chemotherapy is increasingly refined, and BRCA genetic testing plus maintenance therapy with PARP inhibitors have brought significant survival improvements for patients.

Causes and Risk Factors

The exact cause of ovarian cancer is unknown, but risk factors include: increasing age (most common after menopause), never having given birth, early menarche or late menopause, endometriosis, and obesity. The more times a woman ovulates, the more opportunities for repeated repair of the ovarian epithelium, which is thought to be related to risk.

Genetic factors deserve special attention: women with BRCA1/BRCA2 gene mutations have a significantly higher risk of ovarian cancer. If multiple family members have had breast or ovarian cancer, genetic counseling and testing should be considered, and high-risk individuals may even have the option of preventive surgery. In contrast, childbirth, breastfeeding, and oral contraceptive use are considered protective.

Common Symptoms and Warning Signs

The symptoms of ovarian cancer are vague and persistent, including: persistent bloating (clothes feeling tighter), pelvic or abdominal pain, feeling full after eating only a little, nausea, changes in bowel habits, and frequent urination. The key feature of these symptoms is that they are 'persistent and newly onset' — if they occur almost daily and last for several weeks, they should not be ignored.

In advanced stages, ascites may cause noticeable abdominal swelling, along with weight loss and fatigue. Because the symptoms so closely resemble digestive problems, if gastrointestinal tests find no cause and symptoms persist, you should proactively ask for a pelvic examination.

Diagnosis and Staging

Evaluation usually begins with a pelvic ultrasound to assess the appearance of an ovarian mass. The CA125 tumor marker in the blood is an important supportive indicator, but elevated CA125 can also be seen in benign conditions such as endometriosis and pelvic inflammatory disease, so interpretation requires particular caution in premenopausal women. Confirmation relies on tissue examination obtained through surgery or biopsy.

Staging uses the FIGO system: Stage I is confined to the ovaries, Stage II has spread to other pelvic organs, Stage III involves abdominal spread or lymph node involvement, and Stage IV indicates distant metastasis. Most epithelial ovarian cancers are already Stage III at diagnosis, but even in advanced stages, aggressive surgery and drug therapy can still bring long-term remission.

Overview of Treatment Options

Surgery is the cornerstone of ovarian cancer treatment, with the goal of removing as much visible tumor as possible (debulking surgery). The cleaner the removal, the better the prognosis. Some patients receive several cycles of chemotherapy first to shrink the tumor before surgery. After surgery, platinum-based chemotherapy is the standard.

Maintenance therapy represents the biggest advance in recent years: for patients with BRCA mutations or homologous recombination deficiency (HRD), using PARP inhibitors after chemotherapy can greatly prolong the relapse-free period. Anti-angiogenic targeted drugs and ADC drugs (such as those targeting FRα for relapsed patients) are also continually expanding the treatment landscape. Genetic testing (BRCA/HRD) after diagnosis has therefore become a standard step.

Clinical Trials: One More Treatment Option

Clinical research in ovarian cancer is currently exploring new combinations of PARP inhibitors, ADC drugs, and immunotherapy combination strategies, offering new directions for patients with relapsed or refractory disease.

The CancerLink platform can screen for gynecologic cancer clinical trials recruiting in Hong Kong based on cancer type, stage, and genetic mutations. After successful matching and enrollment, all study-related treatment costs are covered. Patients are advised to keep their genetic testing reports to facilitate matching with suitable trials.

If you have persistent bloating or abdominal pain with no identifiable cause, take one extra step for yourself — ask for a pelvic examination. If you have been diagnosed with ovarian cancer, remember to get BRCA genetic testing first, as it may directly determine whether you can benefit from maintenance therapies like PARP inhibitors.